The Pittsburgh Post-Gazette ran a recent story about the increasing numbers of complaints about Electronic Medical Records (EMRs). Like many technological developments, the theory about increasing benefits often masks the reality of implementing the technology. The Affordable Care Act includes provisions requiring that all hospitals and clinics implement electronic record keeping, and it even includes funding to help smaller clinics with the cost of doing so. The idea was that this would help in communicating health information between providers and result in savings for the health-care industry.
From the beginning, attorneys who handle medical malpractice cases have complained about difficulties in understanding the records and following the “trail” of decision-making in hospitals. It is now apparent that many doctors and nurses have experienced the same problems and have been reporting them to the FDA under its adverse events database, known as MAUDE (Manufacturer and User Facility Device Experience).
That database is now being flooded with complaints about how EMRs are resulting in erroneous orders being followed, excessive or inadequate drug dosages given, and erroneous lab reports. As one commentator said, most mistakes “have got something to do with faulty user-device interaction.” In other words, the devices may work fine but they are being used by human beings, who tend to make mistakes. Others say the EMR systems are under-tested, users are under-trained, and there has been little in the way of coordinating experiences across different medical facilities and EMR systems.
Some groups, like the National Nurses United (the largest national nurses’ union) have urged that the race to universal EMRs use be slowed down until there has been “robust research showing that EMRs can and do, in fact, improve patient health and save lives.” They have asked that the FDA test and approve EMR systems just as they do with drugs and medical equipment. So far, the FDA has declined to take on that task.
In today’s world of rapid technology change, it is probably futile to try to slow down medical information technology. In the old days, deciphering bad handwriting was the big challenge. Now the challenge is to understand how EMR systems work and how to track the medical decision-making that is recorded in those systems.
